More patients than ever are relying on physician assistants (PAs) for their care. A core clinical team member in primary care practices nationwide, PAs play a number of essential roles under the supervision of medical doctors. The physician assistant role has expanded over time to include multiple types of PA specialties. Physician assistants now deliver care and support physicians in a number of clinical settings by taking on complex cases. State regulations overseeing PA scope of practice have largely standardized, with it now defined at the practice level by administrators and clinical supervisors.
The flexibility of this open-ended regulatory system allows PAs to easily switch between specialties without having to earn additional credentials. This system of less direct oversight puts a tremendous amount of control in the hands of PAs and their practice to meet patient needs. PAs are able to take it upon themselves to gain the knowledge and skills needed to work in different specialties. PAs are able to gain in-demand skills and pursue their ideal employment situation. While their preferred work environment remains primary care, a record number of PAs are entering specialties. Category 1 CME credits are a key to earning certification in any PA specialty.
Emergency Medicine
The well-rounded expertise of PAs makes them flexible assets in emergency medicine departments where they provide a range of medical services. Nearly 85% of US emergency rooms employ PAs, where many of them provide frontline emergency medical treatment to children, adults and geriatric patients. PAs are also important to emergency department operations, conducting patient triage, overseeing patient transport, working in critical care units and performing administrative functions.
PAs perform a collection of duties that involve both clinical and administrative functions such as taking patient histories, initiating consults, and connecting patients to social services. Emergency medical environments feature a variety of clinical cases requiring a wide range of skills such as wound treatment, differential diagnosis, reading radiological images, resuscitation, treatment monitoring and managing acute mental health crises. PAs must also be prepared to sedate or anesthetize patients in acute emergency situations.
To specialize in emergency medicine, clinicians must combine 75 hours of emergency medicine continuing medical education along with supervised clinical experience. PA candidates specializing in emergency medicine can also earn the Emergency Medicine CAQ (SEMPA) as an elective credential.
Cardiology
PAs provide a broad range of services to cardiology patients under the supervision of cardiologists. Scope of practice can include both routine cardiac care and treating more specialized cardiac cases, including surgery for those qualified. PAs can deliver general cardiac services including performing examinations, ordering and reading lab tests, and prescribing medication. In general practice settings, they are likely to support the long-term care of cardiac patients by diagnosing and managing high blood pressure, heart failure and coronary artery disease. PAs are also trained to conduct specialized medical tests including table tilt stress tests and diagnostic catheterizations.
In hospital settings, PAs can help cardiologists manage higher workloads by conducting rounds and performing consults. PAs trained in surgery may perform lower-risk and less invasive operations like removing stents, placing catheters and retrieving balloon pumps. They can also assist cardiologists in major cardiovascular and thoracic surgical procedures like bypasses, chest tube insertions and pacemaker placement.
Cardiac surgical PA candidates must earn 75 hours of cardiovascular- and thoracic-focused CME credits and have at least two years of experience working as PA. Candidates can also elect to take the Cardiovascular and Thoracic Surgery CAQ to demonstrate their specialized cardiac knowledge.
Psychiatry
PAs are key members of psychiatric treatment teams, assuming a number of important functions in outpatient and inpatient mental health treatment settings. The introduction of PAs into these settings has eased the physician shortages that have prevented some mental health and psychiatric patients from receiving high quality care.
Within inpatient settings, PAs work in conjunction with psychiatrists to manage mental health emergencies and conduct crisis interventions including prescribing medications. Increasingly, PAs are relied on for substance abuse treatment and treating patients in state-run facilities like prisons, overseeing the long-term care of these vulnerable residential patients.
In outpatient mental health settings or in primary care settings where the scope of practice includes mental health care, PAs can perform initial evaluations, taking into account the unique emotional and physical factors that can affect mental health. Depending on the types of psychological or psychiatric disorders being treated, PAs may perform assessments, order and interpret tests, manage acute care, write and evaluate treatment plans and order medication.
To specialize in psychiatry and mental health PAs need a mix of continuing medical education credits as well as supervised hours working in psychiatric environments. Within these environments, PAs will learn psychiatric pharmacology, differential diagnosis, treatment implementation and evaluation. Skills in the areas of patient relations, understanding the impact of social factors on mental health and determining the relationship between physical and mental health are developed.